Long-term clinical and radiological follow-up after laminectomy for cervical spondylotic myelopathy

Abstract

Background:The role of laminectomy in the surgical treatment of cervical spondylotic myelopathy (CSM) is established even though postoperative cervical sagittal balance changes and a risk for long-term instability have been described. The aim of the present study is to investigate its clinical efficacy and the radiological outcome in the long-term.Methods:The authors retrospectively reviewed consecutive cases of patients with CSM, who underwent cervical laminectomy between 1995 and 2010 at the Hospital São João (n = 106). Clinical files were consulted, and the patients reassessed in order to collect information on complaints, previous neurological deficits, surgery and its complications. Subjective and objective clinical evaluation (by three myelopathy scores) and imaging studies were undertaken in order to assess the long-term cervical sagittal curvature and presence of instability.Results:After applying exclusion criteria, 57 patients were able to complete the follow-up. A favorable statistically significant difference was obtained when comparing clinical scores. Ninety-one percent of patients were satisfied with the outcome of the surgery. Only 1 patient developed kyphosis according to Ishihara index and none according to the method of Matsumoto. Four patients developed subclinical cervical instability. No clinical-imaging correlation was found.Conclusions:If patients are properly selected cervical laminectomy without additional instrumentation is effective in offering a clinical improvement to patients with CSM with a low incidence of clinically significant radiological deterioration.

The Change of Range of Motion at Anterior Compression of the Cervical Cord after Laminoplasty in Patients with Cervical Spondylotic Myelopathy

“…Many studies have shown that the surgical outcome of laminoplasty are satisfactory131115182225). However, postoperative complications may arise, including decreased cervical ROM and loss of cervical lordotic alignment, all of which may significantly impair the quality of life4510).…”

“…Another hypothesized cause of the reduction is spontaneous laminar fusion, for which several preventative methods have been considered22). Early mobilization after surgery has been recommended10). These authors claimed that early removal of the cervical collar prevents contraction of the facet joint and postoperative atrophy and dysfunction of the extensor musculature of the cervical spine19).…”

Cervical Spondylotic Myelopathy: Pathophysiology and Surgical Approaches

“…Laminectomy resulted in the enhancement of the JOA score post operation and above 50% of the recovery rate [28][29][30][31]. These studies indicate that this technique provides adequate decompression to the spinal cord.…”

“…Moreover, the authors [29] found that the axial neck pain is correlated with musculature atrophy after the procedure. Another complication of laminectomy is C5 palsy [30,31].…”

Limiting fusion levels by combining anterior cervical decompression and fusion with posterior laminectomy: Technical note

“…22 Studies have demonstrated the complication of laminectomy is development of kyphosis. 23,24 As the literature expands on techniques of treating CSR. The authors report no biases but acknowledge the limitation of small sample size and retrospective nature of study.…”